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          <div style="float: right;">Logged in as: <a href="#">Meskerem Asfaw</a></div>
        <h3 class="muted">Personal health assessment questionnaire</h3>
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            <p>To ensure safe processing please answer the questions below. The information will be stored as part of your medical record and treated as confidential. Please bring this document to the hospital or sent it by mail to the hospital in the enclosed envelope.</p>
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